Andrea Combalia

Clinical and photobiological response in eight patients with solar urticaria under treatment with omalizumab, and review of the literature

Solar urticaria (SU) is a rare photodermatosis. Treatment is challenging, and outcomes are often disappointing. Omalizumab is an anti‐IgE, currently approved for treatment of chronic spontaneous urticaria. We sought to evaluate therapy with omalizumab in refractory SU and describe predictive factors for response.

Rituximab in Refractory Chronic Spontaneous Urticaria: An Encouraging Therapeutic Approach

Background: Chronic spontaneous urticaria (CSU) is a frequent mast cell-driven disease that affects approximately 0.5–1% of the population. Antihistamines are currently the drugs of choice in patients with CSU. Omalizumab has been shown to be very effective in CSU and has been recently approved as second-line therapy. However, although its introduction has markedly improved the therapeutic possibilities for CSU, there is still a hard core of patients who do not respond and require effective treatment. Methods: We report the case of a patient who achieved an 8-month remission of refractory CSU following the use of rituximab, and perform a review of the literature regarding the use of rituximab in CSU. Results: There was a remarkable improvement in her CSU after the administration of rituximab maintained over time. Conclusion: Rituximab is a chimeric murine/human monoclonal antibody directed against CD20, which depletes memory B-lymphocytes that are necessary for autoantibody production. The abrogation of the autoantibody production is the proposed mechanism by which it may alleviate the symptoms of CSU.

Actinic Keratosis—Can Dermoscopy or RCM Differentiate AK (Not Full Thickness Atypia) from Full-Thickness Atypia/Invasive SCC?

Purpose of ReviewActinic keratosis (AK) is the most common sun-induced preneoplastic lesion, and together with photo-aging and skin cancer, it places a huge burden on healthcare systems. The clinical distinction between AK and incipient squamous cell carcinoma (SCC) can be difficult, and therefore, clinical diagnosis is not always reliable and certain. Skin biopsies are sometimes mandatory, and physicians must be aware of the importance of accurate diagnosis and management, as other malignant neoplasms (melanoma, basal cell carcinoma) cannot always be reliably distinguished from AK, especially when pigmented and inflamed.Recent FindingsAlthough histopathology remains the gold standard for differentiation of AK from SCC, some non-invasive optical technologies such as dermoscopy and reflectance confocal microscopy have recently been applied to enhance clinical diagnosis accuracy and to obtain an in vivo characterization of these lesions.SummaryThe combination of dermoscopy with reflectance confocal microscopy improves the clinical assessment and diagnosis of equivocal keratinizing tumors, allows the selection of the most suspicious areas for biopsy, and permits non-invasive determination of treatment outcomes.

Pancreatic panniculitis: A case series from a tertiary university hospital in Spain

Pancreatic panniculitis is a rare type that only occurs in 2–3% of all patients with pancreatic diseases. It is usually described in association with benign pancreatic disease and less commonly in association with pancreatic carcinoma. We describe a case of pancreatic panniculitis as the first manifestation of underlying ampullary adenocarcinoma and a new case of pancreatitis, panniculitis and polyarthritis (PPP‐Syndrome). Pancreatic panniculitis may be the cutaneous manifestation of pancreatic allograft rejection after simultaneous pancreas‐kidney transplantation.

Porokeratosis ptychotropica responding to photodynamic therapy: An alternative treatment for a refractory disease

Porokeratosis ptychotropica (PP) is a rare variant of porokeratosis with a special predisposition to affect body folds, particularly the intergluteal cleft. This disease is resistant to most topical and systemic treatments, as shown in the review of the literature we provide here. Itching and discomfort are often a difficult problem to solve.

Scanning electron microscopy and X-ray microanalysis of reconstructive hair fibers

Background: Reconstructive hair fibers are an innovative tool in cosmetic dermatology based on electrostatic adherent powder which bonds to the hair shaft and can disguise hair loss in men and women. Aim: This study aims to analyze and compare five different brands of organic hair fibers. Materials and Methods: A scanning electron microscope (SEM) was used to obtain amplified images of samples to study their shape and morphological structure. X-ray microanalysis was performed to study the chemical composition of reconstructive hair fibers. The five samples were tested in patients attending a trichology unit of a tertiary hospital. Results: The main component in hair fibers products 1 (Blum Secret™) and 3 (Keratin™) was cotton (cellulose of vegetal origin), while product 2 (Viviscal™) was made of a vegetal keratin. All three samples appeared as parallel-arranged fibres on the scanning electron microscope. The X-ray microanalysis showed an organic polymer mainly composed of C, O, and Si. Hair fibers 4 (Toppik™) and 5 (Nanogen™) were similar. Sample 4 derived from a keratin organic fiber and sample 5 from pure, positively charged keratin. In both cases, SEM revealed microfibers covered by a fine squamous. The X-ray microanalysis in both cases revealed a high presence of S. Conclusion: There was no discrepancy among the cosmetic results of the five samples, providing a successful esthetic effect in all of our patients despite the chemical differences found in the X-ray microanalysis.

Abdominal violaceous skin lesions of a 47-year-old woman following a geometric pattern

We present the case of an obese 47-year-old woman from the Dominican Republic, living in Spain since 2003. She came to our outpatient department reporting a 15-day-history of painful nodules and ulcerations on the abdomen that had been treated by her general practitioner with amoxicilin/clavulanate 875/125 mg t.i.d. for 7 days with no improvement. She mentioned that 8 weeks previously, during a vacation trip to her country, she had undergone a mesotherapy session with injections of a liquid formula containing phosphatidylcholine to reduce the fat from her abdomen. On physical examination redness, swelling, drainage and ulceration were seen at the sites of mesotherapy injection (Fig. 1). Ultrasound imaging revealed subcutaneous edema, but no signs of deep abscessification, and MRI (T2) showed fat necrosis at the sites of injection. A punch biopsy was performed. Histopathologic examination revealed only mild dermoepidermal edema and a mixed infiltrate on the dermis without granulomas (Fig. 2). Periodic-Acid Schiff (PAS) and silver staining were negative as well as Ziehl-Neelsen. Mycobacterium abscessus was identified on skin cultures. Antibiogram is shown in Table 1.

Anagen effluvium following acute colchicine poisoning

We present a case of a 17-year-old girl admitted to the Psychiatric Department recovering from a suicide attempt with colchicine. One week after poisoning, a sudden onset of hair loss was observed. Positive hair pull test and trichoscopy demonstrated the presence of anagen hairs with pigmented long roots covered by the root sheaths. Colchicine poisoning is an uncommon, but potentially life-threatening toxicologic emergency. An overdose of colchicine inhibits cell division, and thus the most affected organs are those which have a high rate of cell turnover. Hair loss resulting from colchicine poisoning presents as anagen effluvium, as it occurs with an exposure to toxic chemicals. Pharmacotherapy or specific treatment is not usually required, since the follicle resumes its normal activity after withdrawal of the antimitotic factors.